Abstract
Imported malaria is the most common cause of fatal infections in returning travellers. The increased amount of both tourist movement and migration has resulted in a growing number of people at risk of infection. In the present study, 507 malaria patients admitted to Italy’s National Institute for Infectious Diseases in Rome between January 1984 and December 2003 were studied. Overall, 445 cases, or 87.7%, were acquired in Africa, of which 55% were acquired in five sub-Saharan countries. Plasmodium falciparum accounted for 393 (77.5%) of the imported cases. Patients consisted of short-term travellers (n = 213, 42%), long-term visitors (n = 134, 26.4%), and immigrants from endemic areas (n = 137, 27%). Malaria chemoprophylaxis was completed in less than one-quarter of all patients, with immigrants having the lowest rate of completion: only 3.6% of immigrants fully completed chemoprophylaxis compared to 31% of short-term travellers and 29.1% of long-term visitors (p < 0.001). Upon multivariate analysis, the lack of chemoprophylaxis was independently associated with the occurrence of severe malaria (p = 0.009). Severe malaria was reported in 59 (11.6%) individuals: all 11 deaths due to severe P. falciparum infection occurred in patients from sub-Saharan countries, two of whom were immigrants from countries where malaria is endemic. Malaria poses a serious health threat to individuals visiting endemic areas. Ensuring the correct chemoprophylaxis for all travellers, including immigrants from endemic areas, and providing prompt access to healthcare providers for unhealthy returning travellers are major points still to be addressed in Italy.
Similar content being viewed by others
References
Newman RD, Parise ME, Barber AM, Steketee RW (2004) Malaria-related deaths among U.S. travellers, 1963–2001. Ann Intern Med 141:547–555
Leder K, Black J, O’Brien D, Greenwood Z, Kain KC, Schwartz E, Brown G, Torresi J (2004) Malaria in travellers: a review of the GeoSentinel surveillance network. Clin Infect Dis 39:1104–1112
Loutan L (2003) Malaria: still a threat to travellers. Int J Antimicrob Agents 21:158–163
Kain KC, Keystone JS (1998) Malaria in travellers: epidemiology, disease, and prevention. Infect Dis Clin North Am 12:267–284
O’Brien D, Tobin S, Brown GV, Torresi J (2001) Fever in returned travellers: review of hospital admissions for a 3-year period. Clin Infect Dis 33:603–609
Askling HH, Nilsson J, Tegnell A, Janzon R, Ekdahl K (2005) Malaria risk in travelers. Emerg Infect Dis 11:436–441
Apitzsch L, Rasch G, Kiehl W (1998) Imported malaria in Germany in 1996. Eurosurveillance 3:35–36
Sabatinelli G, Majori G (1998) Malaria surveillance in Italy: 1986–1996 analysis and 1997 provisional data. Eurosurveillance 3:38–39
Romi R, Sabatinelli G, Majori GC (2001) Malaria epidemiological situation in Italy and evaluation of malaria incidence in Italian travellers. J Travel Med 8:6–11
World Health Organization (1963) Terminology of malaria and of malaria eradication. WHO, Geneva
World Health Organization (2000) Severe falciparum malaria. Trans R Soc Trop Med Hyg 94:1–90
Reyburn H, Mbatia R, Drakeley C, Bruce J, Carneiro I, Olomi R, Cox J, Nkya WM, Lemnge M, Greenwood BM, Riley EM (2005) Association of transmission intensity and age with clinical manifestations and case fatality of severe Plasmodium falciparum malaria. JAMA 293:1461–1470
Muentener P, Schlangenhauf P, Steffen R (1999) Imported malaria (1985–95): trends and perspectives. Bull World Health Organ 77:560–566
Baas MC, Wetsteyn JCFM, Gool TV (2006) Patterns of imported malaria at the Academic Medical Centre, Amsterdam, the Netherlands. J Travel Med 13:2–7
Schoneberg I, Stark K, Altmann D, Krause G (2005) Malaria in Germany 1993 to 2003. Data from the Robert Koch Institute on affected groups of people, countries traveled to and treatment. Dtsch Med Wochenschr 130:937–941
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Spinazzola, F., Nicastri, E., Vlassi, C. et al. Imported malaria at Italy’s National Institute for Infectious Diseases Lazzaro Spallanzani, 1984–2003. Eur J Clin Microbiol Infect Dis 26, 175–179 (2007). https://doi.org/10.1007/s10096-007-0266-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-007-0266-8